Platelet Transfusion: A Clinical Practice Guideline From the AABB
Platelet Transfusion: A Clinical Practice Guideline From the AABB
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DOI：
10.7326/m14-1589
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发表时间：
2015-02-03
影响因子：
39.2
通讯作者：
Tobian, Aaron A. R.
中科院分区：
文献类型：
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作者：
Kaufman, Richard M.;Djulbegovic, Benjamin;Tobian, Aaron A. R.
背景：AABB（前身为美国血库协会）制定了关于成人患者适当使用血小板输注的指南。方法：这些指南基于对随机临床试验和观察性研究（1900 年至 2014 年 9 月）的系统回顾，这些研究报告了接受预防性或治疗性血小板输注的患者的临床结果。专家小组审查了数据，并使用建议分级评估、制定和评估 (GRADE) 框架制定了建议。建议 1：AABB 建议预防性输注血小板，以降低因治疗引起的低增殖性血小板减少症住院成年患者发生自发性出血的风险。 AABB 建议对血小板计数为 10 x 10(9) 细胞/L 或更低的住院成年患者进行输血，以降低自发出血的风险。 AABB 建议最多输血一个单采设备或同等设备。剂量越大并不越有效，相当于标准单采血液成分一半的较低剂量也同样有效。 （等级：强烈推荐；中等质量证据）建议2：AABB 建议对选择性中心静脉置管且血小板计数低于 20 x 10(9) 细胞/L 的患者进行预防性血小板输注。 （等级：弱推荐；低质量证据）建议3：AABB 建议对选择性诊断性腰椎穿刺且血小板计数低于 50 x 10(9) 细胞/L 的患者进行预防性血小板输注。 （等级：弱推荐；极低质量证据）建议 4：AABB 建议对接受重大选择性非椎管内手术且血小板计数低于 50 x 10(9) 细胞/L 的患者进行预防性血小板输注。 （等级：弱推荐；极低质量证据）建议 5：AABB 建议不要对非血小板减少症且接受体外循环心脏手术的患者进行常规预防性血小板输注。 AABB 建议对出现围手术期出血并伴有血小板减少和/或血小板功能障碍证据的搭桥患者进行血小板输注。 （等级：弱推荐；极低质量证据）建议6：AABB 不能推荐或反对接受抗血小板治疗的颅内出血（外伤性或自发性）患者的血小板输注。 （等级：不确定的推荐；极低质量的证据）
Background: The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients.Methods: These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.Recommendation 1: The AABB recommends that platelets should be transfused prophylactically to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapyinduced hypoproliferative thrombocytopenia. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 x 10(9) cells/L or less to reduce the risk for spontaneous bleeding. The AABB recommends transfusing up to a single apheresis unit or equivalent. Greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective. (Grade: strong recommendation; moderate-quality evidence)Recommendation 2: The AABB suggests prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count less than 20 x 10(9) cells/L. (Grade: weak recommendation; low-quality evidence)Recommendation 3: The AABB suggests prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count less than 50 x 10(9) cells/L. (Grade: weak recommendation; very-low-quality evidence)Recommendation 4: The AABB suggests prophylactic platelet transfusion for patients having major elective nonneuraxial surgery with a platelet count less than 50 x 10(9) cells/L. (Grade: weak recommendation; very-low-quality evidence)Recommendation 5: The AABB recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. The AABB suggests platelet transfusion for patients having bypass who exhibit perioperative bleeding with thrombocytopenia and/or evidence of platelet dysfunction. (Grade: weak recommendation; very-low-quality evidence)Recommendation 6: The AABB cannot recommend for or against platelet transfusion for patients receiving antiplatelet therapy who have intracranial hemorrhage (traumatic or spontaneous). (Grade: uncertain recommendation; very-low-quality evidence)